Form 44

(Title as in the action)

QUESTIONNAIRE FOR THE EXAMINATION OF (NAME OF INDIVIDUAL JUDGMENT DEBTOR)

Please be informed that you, (name of judgment debtor), have been summoned by the abovementioned judgment creditor to attend at the State Courts on (date and time) to —

(a)provide answers to the questions set out herein; and

(b)produce documents set out below:

(i)your bank statements for the past 6 months;

(ii)your payslips for the past 3 months;

(iii)your income tax returns and Form IR8A for the last period of assessment;

(iv)your last 3 statements from the Central Provident Fund (CPF) Board;

(v)your last 3 statements from the Central Depository (CDP) and/or your securities broker or fund manager in respect of your shares, bonds and/or unit trusts;

(vi)your motor vehicle log card/printout of your vehicle registration details and hire purchase agreement in respect of your motor vehicle;

(vii)your lease agreements, title deeds or certificates of title in respect of your properties, or your rental agreements.

Please answer these questions carefully as the Court will require you to confirm on oath that your answers are true to the best of your knowledge, information and belief. Please bring this completed questionnaire and the documents with you at the Court hearing.

IMPORTANT NOTICE: You are required to attend the hearing unless you have obtained the consent of the judgment creditor to dispense with your attendance in Court or to discharge the Order requiring your attendance. If you fail to attend the hearing without obtaining the consent of the judgment creditor, the judgment creditor may commence committal proceedings against you for your failure to attend Court. The penalty that may be imposed by Court for such failure is fine and/or imprisonment.

You may therefore wish to contact the solicitor for the judgment creditor (name of law firm and solicitor having conduct of the case) at (address and telephone contact no.) to obtain the consent of the judgment creditor for the necessary dispensation and discharge. You may also choose to engage your own solicitor to advise you on your rights and duties in relation to these proceedings.

Personal particulars

1. / Full Name:
2. / NRIC/Passport No.:
3. / Home Address:
4. / Mobile Number:
5. / Email Address:

Work particulars

6. / Occupation:
7 / If you are an employee, please state the following:
(a) / the name and address of your employer;

(b) / your monthly income; and
(c) / when your monthly income is paid to you and how you are paid (whether by GIRO or otherwise).
8. / If you are self-employed, please state the following:
(a) / the name and address of your business (sole proprietorship or partnership);
(b) / the nature of the business; and
(c) / your monthly income including salary, allowances, commissions and bonuses.
9. / Aside from your income from your employment, please state all your other sources of income and the amount received.

Particulars of your Debtors

10. / Please state whether you have any debtors.
Yes / No.If yes, please provide the details in Annex A

Particulars of your immovable properties situated locally or overseas

11. / Please state the following if you own any immovable property locally or overseas:
(a) / the address(es) of property owned;
(b) / the names of joint-owners (if any); and
(c) / the names of mortgagee/chargee (if any) and the amount outstanding.
12. / Please state if you are leasing any immovable property.
Yes / No.If yes, please provide the details in Annex B.
13. / Please state if you have any tenants/subtenants in respect of your owned or leased properties.
Yes/No.If yes, please provide the details in Annex B.

Particulars of your motor vehicles

14. / Please state if you own a motor vehicle.
Yes/No.If yes, please provide the details in Annex B.

Particulars of your bank accounts

15. / Please state the following if you have any bank accounts or safe deposit boxes:
(a) / name and branch of the Bank where your account or safe deposit box is maintained;
(b) / the account number;
(c) / type of account held (e.g. current, savings, fixed deposit, overdraft);
(d) / name of joint account holder (if any);
(e) / the balance due to you at this date (for fixed deposits, please state the date of maturity and the amount due to you at that date)

Particulars of your other assets

16. / Please state if you have any insurance policies.
Yes/No.If yes, please provide details in Annex C
17. / Please state if you own any shares and/or unit trusts.
Yes/No.If yes, please provide details in Annex C
18. / Please state if you are a beneficiary under any trust, will or estate in intestacy.
Yes/No.If yes, please provide details in Annex C
19. / Please state if you are a member (whether in Singapore or overseas) of any country clubs, timeshare holiday clubs.
Yes/No. If yes, please provide details in Annex C
20. / Please state if you own any other assets, savings or investments not listed thus far (e.g. antiques, collectibles, jewellery, paintings).
Yes/No. If yes, please provide details in Annex C
21. / What offer of repayment do you wish to make to the judgment creditor?

Additional questions by the judgment creditor

22.(Please state additional questions if any.)

Confirmation statement

I, (name of judgment debtor and NRIC No.) confirm that my answers to the questions above are true to the best of my knowledge, information and belief.

(Signature of judgment debtor)

Dated thisday of 20

ANNEX A

Particulars of Debtors and Creditors

(From Question 10)

(1)Please list the names of your debtors (i.e. people who owe you money) as follows:

Name / Contact Particulars / Amount owed / Due date for payment / How did the debt arise?

(2)Please state the following if you have commenced legal proceedings against your debtors to recover your debt:

Name of
Debtor / MC/DC/Suit No. / Amount claimed / Status of action

ANNEX B

Particulars of Property Owned or Rented

(From question 12)

Please provide details of the immoveable property that you have leased out:

(3)Name of landlord:

(4)Address of rented property:

(5)Period of tenancy:

(6)Amount of monthly rental paid and due date of rental:

(7)Whether there is any written tenancy agreement:

(From question 13)

Please provide details of the tenancy of any immoveable property that you own:

(8)Name of tenant:

(9)Address of tenanted property:

(10)Period of tenancy:

(11)Amount of monthly rental received and due date of rental:

(12)Whether there is any written tenancy agreement:

(From question 14)

Please provide details of any motor vehicles that you own:

(13)The registration number of the motor vehicle(s):

(14)The colour and make of the motor vehicle(s):

(15)Whether the motor vehicle(s) is/are on hire purchase:

(16)If on hire purchase, the name of the finance company and the amount outstanding under the hire purchase agreement:

ANNEX C

Particulars of Other Assets

Insurance Policies (From Question 16)

Name of
Insurer / Type of policy/ Policy No. / Amount insured / Monthly premium
payable

(17)Please identify the beneficiaries under your insurance policies apart from

yourself:

(18)If applicable, please state the dates when each of your insurance policies will mature and the surrender value as at this date:

Shares (From Question 17)

(19)If you own shares, please state the name of the company and the number of shares held. If you use a securities broker, please give particulars:

(20)If you own unit trusts, please state the name of the bank/financial institution managing your unit trusts:

(21)Please state the estimated value of the shares/unit trusts:

Beneficiary of trust, will or estate in intestacy (From Question 18)

(22)Please state the name of the person managing your beneficial interest i.e. your trustee, executor (where the deceased left a will) or administrator (where the deceased left no will):

(23)Please state the name of the party leaving you the beneficial interest:

(24)Please state the value of your interest:

(25)If probate or letters of administration have been granted, please state the case no. for the grant:

Other Assets (From Question 20)

(26)Please provide details of the assets listed in Question 20 and state the estimated value of each asset and the basis for the estimation: